A Conservative Manifesto

First it was Charlie Gard, now it’s Alfie Evans. Anyone could be next.

It is difficult to explain just how much I am appalled and disgusted by the statements of Dr. Dominic Wilkinson of Oxford University regarding Alfie Evans as reported in the US by CNN. Assuming that he was quoted fully and accurately—which with CNN is certainly questionable—then I think he ought to give serious thought to a career change. I hear that there is a serious shortage of undertakers, so maybe that might be an appropriate option. Certainly he should stay far away from anything to do with keeping people alive. It is certain that I would never allow him to treat my daughter, knowing how he thinks about these issues

He was quoted as saying that “Sometimes, the sad fact is that parents do not know what is best for their child. They are led by their grief and their sadness, their understandable desire to hold on to their child, to request treatment that will not and cannot help.” While it is true that parents have an understandable bias for their children, the simple fact is that morally and legally (at least in the US; I don’t know much about UK law in this area), the doctor is not the child’s guardian and has no right to insert himself (or herself) into the decision. A doctor should be a medical advisor and nothing more. He (or she) gives advice to a patient or the legally responsible decision-maker as to the medical alternatives and his recommended course of action. If the patient (or parent) decides to follow a different course of action, that is the patient’s decision and the doctor is obliged to honour that decision, whether or not he agrees with it or even thinks it rational. I might concede that there’s a cause for some action on the doctor’s part if a patient or an external decision maker was showing signs of mental or physical illness, but even there it would have to be a pretty extreme case. In any case, I’m not aware of any reporting suggesting that Mr. or Mrs. Evans were not fully competent.

Reportedly, the hospital staff “refused to help with either ventilation or hydration” for hours when the patient continued to breathe on his own. That is well beyond barbaric and cannot be countenanced from any medical professional. If true, all involved should be struck off and never allowed to practice again. In fact, I would argue that they should be prosecuted to the fullest extent of the law—for torture and child abuse, if nothing else.

Having lived in six countries, including both England and the United States, I am well aware that both England and the U.S. have outstanding medical care. But it is this kind of case that undermines confidence in the state of medical care generally. For myself, I will never allow a physician to take decisions for me so long as I am compos mentis and I have made legal arrangements for a trusted person to make decisions for me if I am not.

The sad fact is that doctors do not and can not know what is best for me—or my child—they are led by their often questionable knowledge of treatment and not the needs or desires of the individual patient, and they often feel that their medical knowledge makes them god-like regardless of their actual limitations. I would far rather trust the judgement of a patient or guardian than a doctor. In fact, I would sooner trust the judgement of the first fifty people in the New York City phone directory than some of the doctors with whom I have worked.

When combined with the travesty that was the Charlie Gard case, this incident has rightly indicted the NHS and British medicine generally. It is difficult to escape the conclusion that one should avoid treatment in the UK at all costs—at least if one wishes to survive, or even have any right to decide about treatment.

Had I the authority, there would be a careful review of all involved with this and similar cases, and I have no doubt whatever that resignations, professional sanctions, and criminal prosecutions would be likely and appropriate outcomes.

I would encourage Dr Wilkinson to give this serious thought, as I don’t believe that there is any ethical ground for the statements he made. In fact, I think he ought to be intensely ashamed of them.